Background and objective.

The medial sural artery perforator flap is vastly versatile. It is characterized by being wide, thin, flexible, adequate pedicle length, reliable vascular anatomy, and has low donor site morbidity. It has been popular in Asia as a good alternative, especially in head and neck reconstruction. But surprisingly, it's not frequently used in America.

In this article, through a review of the literature and our experience from 3 centers in Latin America, we intend to help Latin-American microsurgeons get familiarized with this flap by presenting the surgical technique, the most common applications, and possible solutions to the most common problems encountered.

Methods.

For the literature review, the search was performed on 4 different platforms: Medline, Google Scholar, PubMed Central, and Embase. They were gathered, after exclusion criteria, 572 patients from 36 different publications. In addition to the previous, 34 more patients were added from our own experience in 3 different Latin-American hospitals, from May 2015 to December 2020.

Results.

A total of 606 patients were gathered through the systematic review and our clinical series, 75.1% male and 24.9% females, average age of 49.1 years. This kind of flap is commonly used for oral reconstruction. The average flap size was 54.5 cm2, with a 5.9 mm thickness and an average pedicle length of 9.7 cm. The average time for the flap harvest and surgery was 74 and 370 min, respectively. The complications rate reported was of 12.7%: 3% from donor complications, 4.3% from total flap loss, 4.1% from partial loss and 1.3% from venous congestion.

Conclusions.

In our experience, this flap is relatively simple to dissect, with a slight learning curve, plus has lower donor morbidity than other flaps with the same characteristics. In addition, by having constant anatomy, an extensive preoperative protocol is not mandatory, which facilitates microsurgical planning, especially in most Latin-American centers, where diagnostic studies are not relatively available.

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